The overriding, long-term mission of the Primary Care Coalition (PCC) is to address the healthcare needs of low-income, uninsured individuals and families. To further this aim in the national capital region, PCC envisions a secure, comprehensive, virtual health record for medically underserved patients that is longitudinal, portable, and accessible--spanning all forms of encounters across diverse healthcare settings. PCC's approach is both strategic and pragmatic, coupling major objectives with specific project and implementation goals. The principal forward-looking objective at this time is to implement the health information technology (HIT) infrastructure necessary to support a single, shared electronic medical record (EMR) application that, in turn, will promote the community-wide exchange of patient information for clinical decision support, research, and disease management on behalf of low-income, uninsured people. PCC seeks the commitment of financial resources by AHRQ to enable critical planning to occur among community-based healthcare providers as a defining first step toward implementation of a regional EMR for medically underserved patients in the national capital area. This planning will include collaboration with external healthcare communities across the United States to leverage lessons learned, best practices adopted, and technologies successfully deployed. Planning will further comprise a thoughtful, methodical study and assessment, by PCC and its partnership, of community-based healthcare providers, of the legal, technological, and operational requirements and challenges inherent in an undertaking of this significance and complexity: to devise a viable strategy and point-of-care practicable solution whereby diverse healthcare organizations--with unique management structures, disparate technology platforms, and independent service missions--can continue to own and manage individual datasets while concurrently making relevant information accessible to other regional medical providers treating the same patients.